Health Care Innovation Awards: Project Profile


Project Title: “Integrated inpatient/outpatient care for patients at high risk of hospitalization”
Geographic Reach: Illinois
Funding Amount: $6,078,073
Estimated 3-Year Savings: $18,750,000


The University of Chicago received an award to test a model of care delivery that reasserts the importance of an ongoing doctor-patient relationship. The project will use multidisciplinary teams—including Registered Nurses, Licensed Practical Nurses, social workers, and medical assistants led by Comprehensive Care Physicians (CCPs)—to provide consistent care to Medicare beneficiaries before, during, and after hospitalizations. CCPs will perform rounds in hospitals 48 weeks per year, ensuring they see patients and monitor their health consistently. The targeted population will include beneficiaries with a high probability of hospitalization, making it more likely that CCPs will encounter their patients during rounds in the hospital. Over a three-year period, The University of Chicago program will train an estimated 26 workers and will create an estimated 11 jobs. The new workforce will include a programmer, 4 research assistants, 5 comprehensive care physicians, 2 nurses, a social worker and a medical office assistant.

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